Dr. Sarah Gubara (Host): This is Pediatric Insights: Advances and Innovations with Children's Health, where we explore the latest developments in pediatric care and research. I'm your host, Dr. Sarah Gubara. Cyclosporiasis has quickly become one of the most talked about infectious disease stories this summer, and growing questions are coming from both providers and families.

Today, we're joined by Dr. Zachary Most to discuss what community physicians need to know about the cyclosporiasis infections. Dr. Most is an infectious disease specialist and Associate Medical Director of Infection Prevention and Control at Children's Health. He's also an Assistant Professor of Pediatrics at UT Southwestern.

Dr. Most, thank you so much for joining us today and giving us an overview of this current outbreak and its clinical significance.

Dr. Zach Most: Thank you for having me, Dr. Gubara.

Host: It's wonderful to have you. Now, cyclosporiasis has become a major public health story this summer. What are you seeing clinically, and why should pediatric providers be paying attention to this outbreak?

Dr. Zach Most: Thank you. Yes, it has become quite a story. So, what we're seeing in the United States right now is one of the largest cyclosporiasis outbreaks within the country that we've ever seen on record. The CDC has reported over 4,000 laboratory-confirmed domestically acquired cyclosporiasis cases and is investigating thousands more of potential cases right now.

And while there is a major large outbreak that's been epidemiologically linked to contaminated iceberg lettuce that's affecting many states in the Midwest right now, there are actually multiple, at least four different independent cyclosporiasis outbreaks in the United States right now that's really affecting the entire country.

Historically, most cases of cyclosporiasis that we see in patients in the United States are actually acquired during international travel. But the key message is that today, right now in the summer of 2026, cyclosporiasis is not just a travel-associated infection. Most of the cases that we're seeing this year are being acquired in the United States, most likely through contaminated produce.

Host: Wow. So, cyclosporiasis symptoms can overlap with so many other causes of infectious diarrhea. When recognizing it, what clinical features should raise suspicion for pediatricians?

Dr. Zach Most: That's a very good point, and cyclosporiasis is quite difficult to distinguish from other causes of infectious diarrhea. And in fact, it's not one of the most common causes. So, it's much more common for children and adults even to get infectious diarrhea from viruses and things like norovirus and such that are just more common.

So, the symptoms are not particularly unique. It causes abdominal pain, diarrhea. but in particular, it causes a watery diarrhea. The things that make cyclosporiasis stand out and when you might really want to start thinking about it are when the diarrhea is prolonged, because the diarrhea with cyclosporiasis can last for several weeks and can sometimes be relapsing. So, that's one feature that can make it distinguished from other causes of diarrhea.

Another is that cyclosporiasis is not tested for on some of the most common first-line tests for infectious diarrhea. And so if your initial workups are negative, then you also may want to start thinking about cyclosporiasis.

But the takeaway is that the symptoms of cyclosporiasis overlap a lot with other causes of diarrhea, and you have to have a high clinical suspicion for cyclosporiasis in the right epidemiologic context. For instance, when you're in the midst of a large outbreak like we are right now, or if you know somebody has been exposed to contaminated food.

Host: So once someone has been exposed, once cyclosporiasis has been suspected, what is the recommended diagnostic testing approach and treatment?

Dr. Zach Most: So, cyclospora can be a bit difficult to diagnose because some of the first-line tests that we might use, like a stool culture or a stool ova and parasites examination, actually do not detect the cyclospora parasite. So, one of the first-line tests that you should consider if you have access to it is a molecular or a PCR test, which usually comes as part of a PCR panel that will include cyclospora as well as usually a dozen or so other pathogens that may cause infectious diarrhea. And if that test isn't available to you, another test that you can use is a modified acid fast staining of a stool specimen. But routine testing usually will not detect cyclospora.

Host: Other than the diagnostic testing approach, what are some recommendations that you have for treating cyclosporiasis?

Dr. Zach Most: So in comparison to a lot of other causes of infectious diarrhea, which are short and self-limited, and we only give supportive care, to people who have the infection, it is actually recommended that for most people with cyclosporiasis to be treated with an antiparasitic medication. Typically, what we would use is trimethoprim sulfamethoxazole for seven days or longer. And this is highly effective in decreasing the duration of symptoms and preventing relapsing of symptoms.

Host: So once we're considering some of the treatment options, are there any recommendations that you have to prevent complications or any recommendations for counseling families that pediatricians could provide, specifically related to hydration, nutrition, or return to school or activities?

Dr. Zach Most: The biggest risk to people with cyclosporiasis is that they may become dehydrated from the diarrhea. So, it is very important when patients are having active infectious diarrhea from cyclospora or any other cause to maintain adequate hydration, which includes a lot of oral fluids to try and prevent them from needing to go to the emergency room or to a hospital.

If you do feel that your child is becoming dehydrated, perhaps because they're not making wet diapers, or just their urine output is really low, their eyes look sunken, they're not waking up so easily, then you should definitely contact your pediatrician or go to an emergency room if you're concerned. Because occasionally, in rare circumstances, children will need intravenous fluid hydration to be able to prevent complications from the dehydration. That being said, most people with cyclosporiasis will be able to maintain their hydration just by mouth and will be able to treat this at home until the symptoms resolve.

When it comes to return to school and activities, one thing about cyclosporiasis is that it is not usually transmitted from person to person. So, we don't worry too much about outbreaks at schools or any other daycare places or such. So, the main guidance for return to school is when your child is feeling well enough to be at school, maintain their hydration, and have all of their normal activities so that they're able to keep up with their activities at school. If your child is diapered still or incontinent, you should wait until the diarrhea has completely resolved before returning to school though.

Host: That's great to know. Are there any other steps that families can take to reduce future risk of cyclosporiasis infection?

Dr. Zach Most: So, cyclosporariasis outbreaks in the US are not happening all the time every day. And so, perhaps the most key aspect of preventing cyclospora is staying up to date with announcements from the CDC or your state health department or the FDA about any known cyclospora outbreaks. And if they are traced back to a certain product, to avoid eating the contaminated product. Pay attention if there's any recalls. If you find something in your pantry that's been recalled, do not eat it and get rid of it appropriately.

In addition to that, if you're going to have any fresh produce, in general, make sure to wash the produce thoroughly before eating it. And also if you're going to cook produce, make sure to cook it thoroughly as well.

In addition, while this particular parasite isn't usually transmitted person to person, it's always a really important idea to wash your hands, practice good hand hygiene whenever you're preparing food for yourself or for others.

Host: We love great hand hygiene. Is there anything else you'd like community pediatricians to know as they care for children during this increase in cyclosporiasis cases?

Dr. Zach Most: I think the major takeaway here is awareness because as I mentioned before, the symptoms are not going to stand out as being cyclosporiasis. So, you need to be aware of an outbreak going on and through that have suspicion in the right clinical context so you can send the appropriate testing and get patients their appropriate treatment and guidance for overcoming this illness.

So, pay attention to alerts that come from health departments and from other health sources to understand where these outbreaks may be coming from whether they are ongoing, when they resolve. Cyclosporiasis outbreaks usually only occur in the summer. And so, as we enter into the fall, it is likely that the case numbers are going to come down.

But in the past, you may have thought of cyclosporiasis as mostly being a disease for people that are returning after they've been traveling internationally. But that's not the case anymore. You have to consider it for your local patients, in particular when the diarrhea is prolonged and relapsing.

Host: Dr. Most, thank you so much for helping us dive into this trending story across the country. We are so grateful for you taking the time to explore with us what has been helpful, what's going on, and thank you so much for your time.

Dr. Zach Most: Thank you very much, Dr. Gubara.

Host: Of course. Thank you. And for our audience listening to Pediatric Insights: Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research. You can find more information at childrens.com. And if you found this podcast helpful, please rate and review or share the episode, and please follow Children's Health on your social channels.